Stroke Treatment & Rehabilitation
The neurologists and neurosurgeons at the Cushing Neuroscience Institute Stroke Center within North Shore-LIJ Health System provide the region's most advanced care and treatment for ischemic strokes, hemorrhagic strokes and related neurological conditions.
Stroke Treatment:
Stroke treatment at the Cushing Neuroscience Institute Stroke Center includes education about stroke prevention and risk factors, as well the development of a plan of care for those living with the effects of stroke.
Medical Therapy:
Tissue Plasminogen Activator (tPA) is an FDA-approved, clot-busting drug. It must be administered within three hours from the onset of symptoms. Generally, only 3% to 5% of individuals who suffer a stroke reach the hospital in time to be considered for this treatment. To determine if Tissue Plasminogen Activator (tPA) is appropriate for the patient, the doctor must take into account many factors. Some individuals may arrive at the hospital within the three-hour window and not receive this medication for safety reasons.
Preventive Treatment:
Antiplatelet agents such as aspirin, clopidogrel (Plavix), aspirin combined with extended release dipyridamole (Aggrenox) and anticoagulants such as warfarin (Coumadin) interfere with the blood’s ability to clot and can play an important role in preventing stroke.
Surgical Care:
Carotid endarterectomy is a procedure in which harmful plaque in the carotid artery is surgically removed. Depending on the type of stroke, location and when the stroke occurred will help determine what type of surgical intervention is appropriate. When stroke is causes by a burst vessel in the brain and blood is causing pressure within the head, a craniotomy may be performed. A craniotomy is a procedure that removes a piece of the bone of the skull so that access to blood is possible and pressure on the brain may be relieved.
Endovascular Stroke Treatment:
An emerging, minimally invasive method for treating strokes, endovascular stroke treatment is not offered at all hospitals. For these types of procedures, a catheter is inserted into an artery in the groin and threaded through the body up to the brain where the blockage is occurring.
Multiple devices are currently available at North Shore University Hospital for endovascular stroke therapy, including:
- standard microcatheter delivery of intra-arterial tPA
- the EKOS ultrasound enhanced thrombolysis catheter
- the MERCI Retriever
- intracranial angioplasty balloons and stents
The newest device approved by the FDA for vessel recanalization in stroke is the Penumbra Stroke System. The main component of the system is the reperfusion catheter which utilizes suction to aspirate clots through the device like a vacuum cleaner. A separator, gently extruded in and out of the catheter into the clot, prevents plugging of the reperfusion catheter tip.
In the recently completed Phase 2 Penumbra Trial, of which North Shore University Hospital was a participant, partial or complete recanalization (opening a blocked blood vessel) of the target vessel was achieved in 82% of patients, compared to 48% in the pivotal MERCI Trial. Recognizing appropriate candidates for these life-saving interventions, proper early management, including judicious use of IV tPA, and strict post-stroke care are all critical to achieving good patient outcome.
Patients are candidates for an endovascular procedure if there is the sudden occlusion (obstruction or closing) of a large cerebral artery (e.g., internal carotid, middle cerebral and basilar arteries) that results in devastating infarction of extensive portions of brain tissue. Patients with large artery acute ischemic stroke have a very high mortality rate, ranging from 30-90%, and there is significant disability in those who survive. Spontaneous large artery revascularization is infrequent, and the recanalization rate of these vessels with standard intravenous tPA therapy is less than 30%. For patients who fulfill strict clinical and time criteria, endovascular stroke treatment has given hope for patients presenting with these large cerebral infarctions.
Stroke Rehabilitation:
Rehabilitation is a critical part of recovery for many stroke patients. The effects of stroke may mean that one must change, relearn or redefine how one lives. Following stroke, a person may have difficulties functioning physically (e.g., unsteady gait, weakness or paralysis), cognitively (e.g., memory, language or perceptual problems) or emotionally (e.g., anxiety and depression).
Stroke rehabilitation helps individuals return to independent living. Each person is unique, and rehabilitation will be tailored to the individual’s specific needs. The comprehensive rehabilitation team can include a rehabilitation doctor (physiatrist), rehab nurse, physical therapist, occupational therapist, speech-language therapist, social worker, neuropsychologist and recreation therapist. Successful rehabilitation depends on:
- How early rehabilitation begins
- Extent of the brain injury
- Survivor's attitude
- Expertise and dedication of the rehabilitation team
- Cooperation of family and friends
To make an appointment at the Stroke Center:
Cushing Neuroscience Institute’s Stroke Center makes it easy for you to take the first steps in ensuring the best neurological and neurosurgical care for yourself or your family. Simply email us at neuro@nshs.edu, call us at (516) 562-3064 or fill out our Request an Appointment form.